Retreat

1
Name
First Name
Last Name
2
Email Address
example@example.com
3
Your Age?
4
Where are you from? Where were you raised and where do you currently live?
Huge
Large
Normal
Small
Ok
Ok
5
What was your childhood like?Just a brief description - anything notable that would help me understand you.
6
Do you currently struggle with any mental health conditions?
Huge
Large
Normal
Small
Ok
Ok
7
Where (if at all) do you currently feel "stuck"? This could be in your relationship, friendships, work/career, spiritual journey, trauma healing, etc.
Huge
Large
Normal
Small
Ok
Ok
8
What would you bring to this immersion experience?How do you see yourself showing up in a group setting?
Huge
Large
Normal
Small
Ok
Ok
9
What (if any) experience have you had with personal development work?
10
Are you willing to invest in your own growth?Typing YES can be a powerful affirmation to ourselves and to the Universe that we are READY for more.
11
What is your intention for this immersion experience?
12
At this time, what are you most hoping to gain out of this immersion experience?There is no wrong answer :)
13
Is there anything else I should know about you that would help me better serve you?
Huge
Large
Normal
Small
Ok
Ok
14
THANK YOU for your submission!Please submit your deposit of $500 to venmo account @JESSAMENDOLA. If you prefer to be billed, please email info@jessicaamendola.com to request an invoice. Due to limited spaces, this deposit is nonrefundable but is transferable. If you need to cancel, this amount can be credited towards a future retreat or private coaching sessions.
Should be Empty: